Deschutes Rim Health Clinic History
When was the idea for a clinic formed?
In 1997 a group of community volunteers formed White River Health & Living (Canyon Rim Manor) as a nonprofit group aimed at creating jobs and providing senior retirement living opportunities so residents can remain close to their relatives and creating local health care services which normally had to be obtained from Madras or The Dalles — at 40-50 miles each one way trip. White River Health & Living separated into two separate boards, with the Health & Living Board directing the Assisted Living Center, Canyon Rim Manor, and the White River Health District Board directing continued efforts towards opening a medical clinic. Both have a South Wasco County focus. In 2001 the White River Health District Board approached the voters of South Wasco County with the proposal of a tax health district with a tax levy of $0.25 per thousand on property tax assessments. This amounts to about $50,000 annually. The voters approved the concept with nearly a 70% majority.
When was the board first established?
The first White River Health District Board of Directors was voted in during the same election that established the district in 2001.
What is White River Health District?
The District is a taxing agency under Oregon’s Special District regulations. White River Health District exists to provide basic medical and health care for the residents of Sportsman’s Park, Wamic, Tygh Valley, Pine Grove, Juniper Flat, Maupin and South Junction. The District has the same boundaries as South Wasco School District except for the City of Shaniko. The Deschutes Rim Clinic is supported by the tax payers of South Wasco County. All living or visiting in the area are invited to utilize the services of Deschutes Rim Health District regardless of their ability to pay for services. The goal of the District is to provide care to anyone needing care. We accept all insurances and are In-Network for many. The tax revenues help cover the operating expenses of the District.
What has the process been from inception to now?
White River Health District saved up tax revenues from 2001 to the summer of 2007 to help make the building loan payments and equip the clinic for its opening in September, 2007. We had hoped it would also be enough to operate the clinic for at least one year, but delays in receiving insurance payments for over six months required that we take out another loan to assist in operational expenses: salaries, insurances, utilities. Plus we have the smallest tax base for a health district in the state. Most health districts’ tax base is at least three times ours. This, in addition to the loss of an arbitration settlement in December, 2008 with the builder of our structure, has created a huge debt burden for us. We are a non-profit, public entity, which means we are YOUR clinic. We need your continued support to keep our doors open. We also accept donations, which are TAX DEDUCTIBLE, and allow us to plan for future equipment needs and expenses. Donations received in our second year allowed us to buy a full cardiac defibrillator AND an AED to be used by both the medical and dental clinic as needed. With the help of donations and a grant from Special Districts we were able to install outside low voltage perimeter lighting, building security lighting and helipad lighting so Lifeflight will have a safe place to land. Eventually we would like to build a helipad that does not require us to shuttle cars out of the parking lot! Read on to find out how we have evolved and where we’re headed.
2009: We had to ask the voters to approve an Option Tax Levy in 2008 which started bringing in a little more in taxes to help start paying ahead on the loans taken to start the clinic. It passed by a small margin, but it passed! It takes at least five years for a business to feel like it is on the road to being solvent, but for us that meant we had to have the additional in our tax base to even make ends meet.
2010: We are completed our first year with the increased taxes and it has allowed us to actually take a breath and know we can pay our bills! Thank you, South Wasco County!
2011: We completed our third year in operation and are now facing our second financial audit. This went much smoother than the first, as we had no idea what to expect the previous year. Oster Professional Group out of John Day was MOST patient and very easy to work with making this potentially heart-stopping event actually easier to get through. Now if Sharon can just clone herself so there is enough time to accomplish everything that comes due at the same time as the audit! Sharon was voted to become a member of the Central Oregon Independent Practitioners Association (COIPA) in Bend; lots of traveling, but this has been very informative in understanding how the insurance credentialing and contracting process works.
2012: This year was very challenging as we had quite a few employee changes, mainly due to health reasons. Oregon Health Plan patients saw a big change in the wind, with local governing of their benefits, called the CCO (Coordinated Care Organization). We started the process of becoming a Patient Centered Primary Care Home, which helps every one of our patients, but requires a lot of training and set-up on our part. The District also sponsored its first community event, the Walk/Run for Riverfest, with a new logo designed by our own Brandy Gooch.
2013: We seated a new Board in July — or at least 3 of the 5 members, retaining our Chairman, Dennis Beechler and Secretary, Karletta Carrithers. They are the backbone of our organization, having been part of this process since its inception. New to our board are Vice Chairman, Brian Manning and Members Sandi Chamberlain and Gerri Johnson. In October we had two bonuses: 1) our audit showed we were well on our way toward becoming a solvent business, and 2) we were awarded a Tier 2 level (out of 3 tiers) Patient Centered Primary Care Home certification. Sharon attended a week-long training in Behavioral Health to see how we can implement a new program in our clinic. We again sponsored the Riverfest Walk/Run, which changed to early summer this year. The Columbia Gorge CCO is off and running. Sharon was appointed to sit on the overall governing Health Council as Wasco County’s member at large. There are a lot of very committed people in Wasco and Hood River counties working for those residents with Oregon Health Plan. Sharon continues to sit on and work with the Central Oregon IPA Board of Directors and the Columbia Gorge Health Council, and states, “It is a pleasure to work alongside them.”
2014: This past year has seen us continue to provide employment for local individuals. Kimberly Stebbins joined us in February as our Administrative Assistant. She monitors our website emails, the Patient Portal, all licensing and credentialing, assists Sharon and LeeAnn with the billing as Susan (our former biller) left in the summer, and took on the job of applying for our 501(3)c status with the IRS as the Deschutes Rim Clinic Foundation in memory of Deanna McDowell.
Emily Black, sister to Sarah Morelli, came home and joined our staff in the summer as a dental assistant for Dr. Balentine and a medical assistant for us. We have trained her to do blood draws to help LeeAnn, and she is very good. She and her new husband are also training to become EMTs for Maupin Ambulance.
Debra Ross, who is a Registered Nurse, joined the staff in late summer to help with the medical assisting and is learning how to help me with Care Coordination. She will be contacting patients by phone as well as seeing them in the office.
This year also saw us contract for some specialty services; we have contracted with a Behavioral Health Counselor, Stephen Woolpert, and a Consulting Pharmacist, Kevin Holman.
We now feel we have a staff fully committed to the improvement of our services to the people of South Wasco County.
We had our first strategic planning retreat in October and also attended the Rural Health Conference, which energized us all toward continued Quality Improvement and provided lots of resources for us.
2015: We were successful in adding a second provider this spring. She is Nina van Es, an adult and geriatric Nurse Practitioner. For her write up, check the provider page.
We have also added her husband, who is a Licensed Professional Counselor , to work as our Behavioral Health Consultant. He is experienced in many forms of counseling, including Family health, depression and grieving, and behavior changes such as smoking cessation and weight loss. He has also participated in addiction and substance abuse counseling. He is working with many of our clients towards a positive life change for themselves.
With the addition of a second provider we have been able to increase our open hours, so that we are now open from 9-5pm, Monday through Friday. The times we will be closed is usually for staff training which must include everyone. If we do not have a provider available, the clinic is not able to be open.
We have held two staff retreats during the past fiscal year; one in the fall of 2014 with staff only, and one in the spring of 2015 which included our board of directors. This is a chance for us to really review changes which are coming to medicine and how will we adapt to them. Here we are in action:
We are a Tier 2 Patient Centered Primary Care Home and will be re-attesting this fall–possibly even as a Tier 3. This is a State of Oregon certification and each level increases our reimbursement from most insurances. No insurance pays the full going rate. They all dicker for the lowest reimbursement possible for them. It is money in their pockets, not ours.
We have made a huge decision this spring, after losing our biller last year, to outsource our billing to someone who understands billing and reimbursements and contracts. LeeAnn, Kimberly and myself have tried to do it over the past year but none of us are experienced and we have been getting alot of rejections from insurances that we did not know how to handle.
We will be building our Care Coordination model now that Nina is here, as she is very experienced in this and will be a great asset. Stay tuned. If you qualify you may be contacted to participate.
We will be continuing to have Strategic Planning Sessions with the staff and the Board to review other necessary changes in the near future.
We were successful this spring in paying off our oldest loan on the business–just like I promised the community.
Oh, and I almost forgot. Please welcome a Physician Assistant student this July. Aaron Inouye will be joining us on June 22 for six weeks. He has not been here before, so if you see him about town, welcome him and show him around.
Our third year as a Patient Centered Primary Care Home, which brings with it a set of requirements for patient care:
- Access to care: Patients get the care they need, when they need it. This includes having access to translators for people who speak a different language or are deaf.
- Accountability: Recognized clinics are responsible for making sure patients receive the best possible care. We have to meet specific standards and quality of care metrics, making sure certain medical conditions are well controlled.
- Comprehensive: Clinics provide patients all the care, information and services they need. If we cannot provide the care a patient needs within the clinic, we will coordinate the referrals they need.
- Continuity: Clinics work with patients and their community to improve patient and population health over time, this includes preventive health guidelines over a lifetime.
- Coordination and integration: Clinics help patients navigate the system to meet their needs in a safe and timely way, including helping with Medicaid enrollment and resources for insurance or medical care coverage.
- Patient and family-centered: Clinics recognize that patients are the most important members of the health care team and that they are ultimately responsible for their overall health and wellness. We believe that the patient is the center of their own care, and that all we can do is to help guide them toward better health; the patient has a vested interest in being responsible for their health.
The last half of 2016 a decision was made by the staff to change our medical database to one which will help us bill for our visits, in addition to providing better accuracy in reporting. Training for this change started in late September, and our transition began on November 15th! As with any change, it has been difficult learning a new ‘language’ and tiring to learn new processes, but we are doing it, and feel, ultimately, this database will be a good asset and resource.
During 2016 we were able to add the 5pm-6pm hour to our schedule, allowing patients to be seen after 5pm. This will hopefully help working patients or those with children who need to be seen. It has taken a few months, but we are starting to see patients use this time slot.
We are slowly working towards building a bigger building right behind the current clinic building as we have outgrown the current space. This will be a 3-5 year project, and we will definitely need the community to help in this matter. We started having some raffles, but raffles alone will not bring us the financial assistance we will need to complete this project. The goal will be to have two full time providers, one to two part time providers, mental health services, some ancillary services, a new dental suite and space for staff where they are not sitting on top of each other. The current building will then be repurposed to as living space for students and part time providers, laundry, exercise room for PT/OT and meeting space.
Goals for 2017:
- Reapply as a Tier 3 Patient Centered Primary Care Home
- Improve insurance reimbursements with participation in Medicare’s CPC+ Program
- Continue incentive programs through Medicaid and commercial insurances
- Hire one full time physician to work with current provider
- Continue to build our client base and services
- Continue to build our pediatric population
- Continue raffles as FUN fundraisers for the Foundation
- Start other fundraising opportunities
- Complete a feasibility study for the Clinic
- Start the efforts toward a third option tax levy, due for 2018 ballots
- Continue to operate with good financial audits as we have for the past five years