Mountainside Family Healthcare is celebrating its three-year anniversary. The walk-in clinic, operated by Sitka Community Hospital, is open 7 a.m. to 6 p.m. Monday through Friday and Saturday 1 p.m. to 5 p.m.

Clinic Manager Patrick Williams and Kay Turner, Director of Outpatient Services, talk about the services provided, which includes radiology, occupational therapy, and speech therapy. They were joined by Dr. Richard McGrath, a primary care provider in the clinic.

McGrath talks about his background in rural medicine in Colorado and overseas, specifically in Asia and Southeast Asia. He tells stories about spooking a herd of cows and climbing a mountain to perform surgery in a hut by headlamp.

Dr. Jason Koskinen is a family medicine doctor with a degree in osteopathic medicine. Formerly at SEARHC’s Mt. Edgecume Hopsital, Koskinen joined Sitka Community Hospital this year. (Photo from Koskinen’s Facebook page)

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Dr. Jason Koskinen has joined Sitka Community Hospital, one of seven new providers. He was joined for the interview by Patrick Williams, clinic manager at Mountainside Family Healthcare. Koskinen is a doctor of osteopathic medicine (D.O.), with special training in hands-on manipulation of the musculoskeletal system. At the clinic, he’ll provide both primary care and preventative care.

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Sitka Community Hospital has brought two new primary care providers – Jeff Bentley and Jason Koskinen – to Mountainside Family Healthcare. Clinic Manager Patrick Williams talks about the services they’ll offer, reduced wait times for patients, and construction plans for the modular unit to enlarge the space in the clinic.

The Mission Statement for Sitka Community Hospital, posted in the waiting room. With this clinic addition, the hospital hopes to expand primary and urgent care services. (Emily Kwong/KCAW photo)

Patrick Williams is the clinic manager at Mountainside Family Healthcare  and Jackie Barnes is a physician’s assistant. Mountainside is expanding its suite of services to include both primary care and urgent care. The Sitka Assembly this week approved adding a modular building, which will allow the clinic to install three more exam rooms.

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In order to survive, Sitka Community Hospital needs to overhaul how it does business. That was the message of an outside consultant to the Sitka Assembly Thursday night (7-13-17). (Emily Kwong/KCAW photo)

Sitka Community Hospital is in the early stages of a make-over. Building upon the recommendations of an outside consultant, Stroudwater Associates, hospital leadership is directing changes to make Sitka Community a standalone operation. Those include discontinuing the labor and deliver program, reducing surgical coverage to daytime appointments, and expanding the clinic.

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“This is one of the swing beds,” says Sitka Community Hospital CEO Rob Allen, as he enters the part of the hospital devoted to long term care.

The rooms are decorated with art and stuffed animals. One resident has propped a photo of Elvis against her window. Of all the recommendations in Stroudwater’s 100-page report, changing how these beds are licensed could reap the largest financial reward for the hospital.

See a Powerpoint of Stroudwater’s report here: Stroudwater Presentation to Sitka Assembly

Hospital CEO Rob Allen takes in a portrait of a former resident. Long term care would continue at the hospital but under the new plan, all beds would be converted to swing beds. (Emily Kwong/KCAW photo)

“We’d take our fifteen long term care beds and put them into that same swing bed status,” Allen says. “It wouldn’t change the way we provide care, but it would change the regulations that we’re working under.”

Patients wouldn’t notice the difference, but the hospital would be reimbursed through the federal Medicare program instead of the state Medicaid program. Stroudwater estimates the bed conversion could mop up a financial return of $1.1 million, but it requires some paperwork. “We also need the state [of Alaska] to go along with it and agree to the change,” Allen added.

Other cost-saving measures don’t require a rubber stamp from the state, but would change the hospital’s relationship to family medicine. Earlier this year, hospital leadership wrote it into the budget to discontinue the obstetrics program, though continue to offer prenatal and postnatal care. Stroudwater supports the idea and estimates the financial impact to be $170,000, but it’s hard to put a price on losing this option for childbirth in Sitka.

The main labor room at Sitka Community Hospital. Phasing out obstetrics would help the hospital’s bottom line, but the idea has been met with resistance by many in the community. (Emily Kwong/KCAW photo)

Nurse Vicki Akins walks us through the OB unit. “We have a whirlpool in the hallway because Sitka women are strong and good labor mamas,” she chuckles, before entering the main labor room. The design is a cross between surgical and spa-chic, with a floral woodcut on the wall. “This is where my daughter was born,” Allen murmurs.

Births at the hospital have declined, from 60 in 2005 to 35 last year. That’s part of the logic for cutting OB, but Akins has her own opinions on that. “In the lower 48, OB units don’t make money either. If we lost this unit, it would be a great loss to the community here,” she says.

Next month, Allen will talk to SEARHC to see if Sitka Community’s family doctors can get credentialed to deliver babies across the bridge. “That’s one of the advantages of having one spot. You could split that up among more doctors and they don’t necessarily lose as many weekends to being on call,” he said.

The surgical unit at Sitka Community Hospital, where a plaque hangs in memory of David Knox, RN. His son Kevin serves on the Sitka Assembly. (Emily Kwong/KCAW photo)

Scheduling is also driving proposed changes to surgery. We pass by the surgical wing next, where Stroudwater says the hospital could save $190,000 by changing the business model. Dr. Richard Wein’s contract was not renewed in February due to an undisclosed personnel matter, a decision met with public disagreement.

Allen wants to move towards scheduled surgeries, Monday through Friday only, and away from 24/7 surgical coverage. “Dr. Wein – that was his style. He’s an old-style surgeon.  And people aren’t interested in providing that kind of coverage on their own,” he said.

Amid these suggestions of where to reduce, Stroudwater said in emphatic terms that the area for growth was in the clinic. They challenged the hospital to increase annual patient volume at Mountainside Family Healthcare by 2500 visits. Manager Patrick Williams believes it can grow by 5000.

KCAW: What tells you it [patient volume] can grow?

Williams: Every provider that we have has a waiting list. We know people want to come in and by seen. I get calls every day, “Can I get in? Can I get in? And we just don’t have the room or the space available.

The space designated for a modular unit that attaches to the clinic, which would require approval from the Sitka Assembly. (Emily Kwong/KCAW photo)

In seeking space for more examination rooms, the hospital wants to purchase a $400,000 modular unit. Ultimately, Allen’s hope is to offer patients same-day appointments and more preventative medicine.

“We want to proactively reach out to people and remind them, ‘Hey, you’re due for this test or you’re due for this.’ Our goal is to develop a team approach to healthcare. You’re not just coming here because you’re sick. We’re working with you to keep you well,” he said.

Since the report became public, every department developed an action plan to get the ball rolling on this new vision. But is the hospital being outlined on paper one that patients would want to visit in person? At least one individual  sitting in the audience at Stroudwater’s presentation said no.

“It seems to be me the model they’ve presented would create a hospital that is an empty shell. A business that doesn’t really provide the services that people need,” said patient Karen Lucas.

She’s also frustrated by the insularity of the two-hospital conversation this past year, which began with collaborative talks under the stewardship of an outside consultant and ended with SEARHC seeking a merger. The Assembly was poised to consider their offer further, until two owners of a local hotel said they were interested in buying the hospital and the city became wary of a sole-source contract with SEARHC. At every stage of the process, Lucas feels the public was left out.

“A hospital is just as foundational as a school. These are life and death issue. This is where people cried and they laughed and they died and they lived and they did all these human things. I think that value has not been honored as it should be,” Lucas said.

The Sitka Assembly will meet this evening at 6 p.m. to discuss the future of Sitka Community Hospital and take action on its management. They could support the hospital in this new vision, put its management out to bid, or something else entirely.

Raven Radio will broadcast the meeting live.

Photo/Jasleen Kaur/Flickr Creative Commons

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Mountainside Family Healthcare’s new Urgent Care clinic is now offering services to the public. Patrick Williams, the clinic’s business manager, and Leah Rose, a triage nurse, joined us in the studio to talk about the services the clinic offers. The clinic is open from 7 AM to 4 PM Monday- Thursday, 9AM-5PM on Fridays, 1-5 PM on Saturdays.

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Sitka Community Hospital.

Swimmers take to the open waters of Sitka Sound, in an annual race that benefits the Baranof Barracuda Swim Club. (Courtesy of changeyourlatitude.org)

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The 8th annual “Change Your Latitude” 57˚ North Open Water Challenge is this Sunday, August 8, 2015. Race Director Kevin Knox is busily preparing for the challenge, which includes a 1k, 3k, 6k, and 10k race that begin at the Coast Guard Gazebo.

Registration for the 3k, 6k, and 10k is still open on the challenge website until 5 p.m. tonight (08-07-15). Registration for the 1k is open the day of the race. All proceeds benefit the Baranof Baraccuda Swim Club.

Skylar Moore, Ava Parrish, and Will Pate are three high school students who are participating in the 3K race, which was just opened to swimmers over 14 years of age. Moore won the Women’s Under 18 1k last year with a time of 8:13 and is excited to take on a bigger challenge this year. She was joined by Patrick Williams, who won the Men’s 10k last year with a time of 2:26:53 and recalls training with Pate amid sea lions.

“I’m constantly getting articles and books from senior staff,” said Rob Allen, who has recently accepted the board’s invitation to stay on as the CEO of the financially ailing Sitka Community Hospital. Allen was considered for the position last year and was brought in after the former hire abruptly quit. (Emily Kwong/KCAW)

After six weeks on the job, Rob Allen – the interim CEO of Sitka Community Hospital – agreed to take on the position permanently. He announced his decision during the hospital board’s last meeting in February (2-26-15) and expects to negotiate for a contract soon.

Hospital management is a new chapter for Allen, who grew up as boat captain in one of Southeast’s most prominent maritime families. He said the hospital’s financial panic has subsided, thanks in large part to the staff members who rode the wave.

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While Rob Allen feels good about his decision, he is the first to say he has some serious reading to do. When he met with KCAW last Wednesday (3-4-15), he was preparing to fly out to Maine to see his daughter. “I’ve got a book about this thick I’m going to be reading on the plane about the medical health care world and operating it as a business,” he said.

Allen was born in Kodiak, but he’s really a son of Sitka. He was raised here and was president of Allen Marine Tours for nearly two decades. When he and his wife moved to Massachusetts in 2008, Allen knew he’d orchestrate a way to come back. His intention was the operate a newly bought charter vessel for the summer, called the Midsummer Dream. Allen said, “My plan was to be one the boat all summer. Instead I’m in my windowless office. (Laughs). That’s the hard part.”

The hospital has found ways to cut cost internally, by cutting overtime pay and enforcing a low census policy, whereby nurses leave work early if there aren’t a lot of patients that day. “You can really see the difference in our bottom line,” said Allen. (Emily Kwong/KCAW)

We’re seated in that windowless, basement office – there’s an open door policy – and though he’s missing a CEO name tag, Allen said he’s become more comfortable with the role since he took office (1-19-15). He has a better grasp of the financial picture, a good rapport with staff, and has made inroads with the Alaska Hospital Association. Last week, Allen went to one of their meetings in Juneau.

Allen: It was a good chance to meet other hospital CEOs and start talking to them. They’re a great resource.
KCAW: Did they know about what happened? Did they ask you?
Allen: Everrrrybody knows what happened. Yes. (Laughs)
KCAW: What did they say?
Allen: Oh they just… most of them were happy to see there was somebody that would step in and take it on.

Allen applied for the CEO job last year, but lost out to Jeff Comer, who had extensive experience in hospital management elsewhere in the country. Some of that experience was of short duration, however, and that would prove to be the case in Sitka. Barely three months into the job, with the hospital in financial disarray, Comer abruptly resigned and around the same time, filed a police report alleging that he was assaulted by an unidentified couple while hiking on a trail.

Chief Nurse Raine Clarke, who served as interim CEO before Allen was brought in, said the circumstances created not just confusion among the staff, but some outright panic.

Clarke reflected on that time, saying, “A little, I mean I can’t even say a little…People were afraid. They were afraid the hospital was going to go under. People were afraid for their jobs. We were trying to make it so that staff could come in and still just feel like they were doing their job and that’s all they had to do. That they didn’t have to deal with everything else that was going on out there.”

“It was tough there for a while, for about a month,” said Patrick Williams, the Program Coordinator. In the wake of the crisis, he said that members of the administrative team would stay until 8 o’clock, sometimes 9 o’clock, at night to come up with ways to put the hospital back together.

Williams motioned to his name tag, where a red button was affixed to the front. He explained that former obstetrics coordinator Ruth Watson took it upon herself to walk around the hospital one day and hand out bright red buttons that said things like “SCH Team. Williams added, “There’s also a little button…I actually don’t have that one on right now…that says SCH will survive.”

To boost morale, Ruth Watson, the former OB coordinator, passed out buttons to staff members like Angela McGraw with messages like “SCH Will Survive” and “SCH Team.” Amid discovery of financial losses and the transition to a new CEO, the hospital staff is determined to move forward. (Emily Kwong/KCAW photo)

(McGraw: Okay, so you’re ready? We’re going to start right here. We’re at the main entrance of the hospital right now.)

I’m walking down the hallways with Public Relations Coordinator Angela McGraw. She said, “I think we’re coming out on the other side of it okay.” Everywhere we go, from the radiology room to IT, people said the same thing: ‘We’re surviving. We’re doing okay.’

(Kilkeary talking to McGraw)

Daniel Kilkeary began work the same month the hospital announced its financial troubles. He said that, despite the crisis, he wasn’t all that worried. “My wife works over in medical records – she does the billing and coding over there – and she always felt like the hospital was sound and it’s just a matter of catching up,” Kilkeary said.

Catching up by cashing in. Allen says that the debt collector they hired brought in $560,000 in January. To cut cost internally, the hospital began enforcing it’s low census policy by sending staff home when the patient count was low.

Census numbers have been low, but throughout the winter, fluctuated as usual. According to Clarke, the hospital provided 83 days of acute care in February, admitted 24 patients through long term care and 159 patients through the Emergency Room. In January, those numbers were 155 days, 25 admissions, and 130 ER patients. In December, they were 129 days, 25 admissions, and 131 ER patients.

So far, there’s been no need to ask for additional loans from the city.

And as the hospital approaches a new budget cycle, Allen plans to open up the strategic planning process to the public through focus groups and two town hall meetings this spring.

Of the decision to make the planning public, Allen said, “It’s kind of credibility issue for me. We want to be able to show the community that we have gone through a good planning process that has credibility.”

When asked if the hospital would ever merge with SEARHC, Allen said he’d at the very least like to explore streamlining services. He talked about the duplicate services offered at both hospitals, saying, “Two emergency rooms. Two OBs. There might be ways we could cooperate or share resources, so there is not so much overlap.”

Allen also wants to get to the bottom of what went wrong in the first place. For that, he hired interim CFO Cynthia Brandt of the Anchorage-based firm WaineBrandt through April. Though it was a perfect storm of problems, blame is shifting largely to the electronic medical system that the hospital implemented last May, called Centric.

“All the systems ground to a halt,” said Allen, “So there was a real slowdown in getting bills out. The decision to pick the system was made a couple of years ago, so I haven’t even found any documents about how evaluation was done or why this one was chosen.”

In such cash-strapped times, it doesn’t seem likely the hospital will expand into a regional healthcare hub, as envisioned by Jeff Comer. Right now, it’s enough to just treat patients who come in and collect the money they’re owed. Allen offered the following analogy from his boat tour days to staff, which Clarke said she appreciated.

“Allen was talking about Allen Marine and said, ‘It’s really nice to take a tour out and have customers pay when it’s beautiful out there and there is a lot of wildlife. But the days you have to take people out on the boat and it’s windy and raining and there is no wildlife, the bottom line is you still have paying customers.’ And so I think that having that mindset can kind of come over to healthcare. Nobody wants to be in a hospital. Nobody wants to have to come and be sick. We just need to focus on our patients.”

A task that’s become a lot easier, Clarke said, with a steady hand at the wheel.

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Premera Blue Cross Blue Shield gave Sitka Community Hospital a $3000 grant for water safety education. As Patrick Williams of SCH explains it, $1500 will be funneled into a 12-month scholarship program directed by Baranof Barracuda Swim Club to teach six children how to swim. Williams was joined by Coach Sioxha Tokman and Board President Kevin Knox to talk about the expansion of the swim lesson program and the upcoming state championship meet in Jueanu. Barracuda is actively looking for swim lesson instructors. Call 738-8155 for more information.