CHA plugs away at merger

11/05/2020

Staffing shortages continue to hobble the Point Reyes and Bolinas health clinics, but the ongoing process of folding the Coastal Health Alliance into the Petaluma Health Center is helping to solve the problem. 

The health centers officially merged four months ago, dissolving the Coastal Health Alliance as a legal entity on July 1, but plenty of work to integrate the two remains. The outcome will hopefully be better recruiting, more expertise, a consistent staff of physicians and the eventual reopening of the Bolinas clinic—a move that residents are calling for with fervor.

Already, the Petaluma Health Center has shown its power by promoting one of its physicians, Dr. Christina Gomez-Mira, to be the lead doctor on the coast, seeing patients next week. She will mentor the clinical staff and serve as the main line of communication between West Marin and Petaluma. 

The health center is also sending another fill-in physician and two nurse practitioners while it searches for a third full-time physician to work permanently alongside Dr. Gomez-Mira and Dr. Anna O’Malley.

Staff turnover and recruiting shortfalls have plagued the alliance for years. The nonprofit has struggled to maintain a consistent staff of doctors in particular, though medical assistants, nurses and receptionists have also been hard to find, especially local hires.

The staffing shortages are blamed for the closure of the Bolinas clinic, which has not seen patients since March. It was originally closed because the alliance consolidated operations to make it easier to follow Covid-19 health and safety protocols; it has remained closed because many of the alliance’s 50 positions are unfilled and employees are having to stay home because of outside exposure to Covid-19. 

“We are barely keeping it together at one site right now,” said Steven Siegel, the alliance’s former CEO who is working as the director of West Marin services until at least the end of the year. 

The Bolinas clinic plays a critical role in allowing aging residents to stay put later in life. Thirty-seven percent of Bolinas residents are over the age of 60, according to Marin County’s aging action plan. Dr. O’Malley said it would take three employees to offer primary care at the Bolinas clinic: a receptionist, a medical assistant and a primary care provider. But the Point Reyes clinic has none to spare.

Bolinas resident Judith Lowry recently had knee surgery and her husband has Parkinson’s disease, so she’s had to hire a driver and take time off work to travel the extra 15 miles to the Point Reyes clinic. It’s been frustrating. “We built [the Bolinas clinic] because we needed it, and this was such a community venture, so to have it disappear without any explanation to us and no signs of reopening, it seems crazy,” she said.

The alliance moved its Bolinas site from a tiny office on Wharf Road to the new clinic on Mesa Road in 2007 alongside the firehouse. The facility was a massive upgrade: The entire project cost $6.5 million, partially funded by a town parcel tax and over $1 million in individual donations, so the town has a proprietary interest in the operation.

Patty Bradford, a nurse practitioner who owned a Bolinas clinic that was folded into the Coastal Health Alliance in 1993, said many residents feel let down and worried about access to health care. The clinic was staffed with local faces; now the administration feels distant. Other than with Dr. O’Malley, communication is lacking, she said. 

Dr. O’Malley has a unique position as both a local and an employee, so she has served as a community liaison. She is taking names for a patient advisory panel that will help inform health center staff, and she sees the struggles as an incredible opportunity. 

“There’s a way of looking at constraints that can inform innovative solutions, and if ever there was a place that people think creatively and out of the box, it’s Bolinas,” she said.

Mr. Siegel gave no timeline for reopening the clinic but said that executives are engaged in finding a solution to bring services back in some form. They are looking at new models, like a residency program that allows doctors to live in town and train in the rural setting, he said. 

The lack of affordable housing is a big hurdle for hiring support staff, so recruiting and training existing residents is on the table. More care could also come in the form of telemedicine, he said.

“Getting it back to how it was is not the solution,” he said. “It’s how to create a new model. We cannot turn the clock back.” 

In response to the criticism, he said, “It’s easier to build a clinic than to operate one, certainly in 2020. One is a finite product, one is a process, and the process is changing all the time. We’re doing our best.”

While high-level discussions about reopening Bolinas are just beginning, patient care in Point Reyes Station is ramping up from the lull of the pandemic. The clinic is increasing its in-person visits from 25 to 45 percent of appointments, and the dental clinic is seeing as many patients as it was before the shutdown. All of this has happened with no evidence of Covid-19 transmission within the buildings. The alliance offered a series of free flu shot clinics and has weekly Covid-19 testing: Next week, there will be a one-time flu shot clinic in Bolinas.

Integrating the alliance with the Petaluma Health Center has been exhaustive, as all systems must be combined. Everything from the sliding-fee scale and bill paying to human resources and employee health insurance must become one. Organizational partners, insurance companies and government agencies had to be notified, and the alliance is completing a financial audit.

In much of the integration, the alliance adopted systems already in use by the larger health center. But in some cases, both parties moved to new systems, like with the dental software used to track tooth work. This involved hiring a trainer to teach dentists and assistants how to use the new program. On Monday, medical records were merged.

The Coastal Health Alliance branding and website remain intact. Mr. Siegel said that changing the branding is not a priority, and the wave logo will stay. The website will increasingly direct to the health center’s site. Employees in Petaluma refer to the operation as “the coast.”

When the alliance dissolved, two board members, William Barrett and Elizabeth Goldblatt, were appointed to the 15-person Petaluma board. They’ve attended four meetings, and Mr. Barrett said he is impressed with the board’s expertise so far. He was skeptical of a merger out of fear of losing local control, but any questions he’s asked have received satisfactory answers. 

“They take us seriously,” he said. “We are an important part of their portfolio of health care, and I have confidence that the Petaluma Health Center will do what they can to maintain services out here, at the same level if not better.”

The health center is 10 times the size of the alliance, so economies of scale are at play. It costs the Petaluma center about $300 less per patient to provide care each year. Both entities receive grants as a federally qualified health center in an underserved area, and the nonprofits share a founder.

Dr. Gomez-Mira has confidence that the merger can improve the quality of care, and she will play an important role in that growth in her two days a week on the coast. 

In Petaluma, she saw a dedication to serving the community and an approach that values whole-person care; she also saw many Latino patients. Her father is from Spain, so she grew up speaking both Spanish and English and worked at clinics on the Texas border.

“I’m coming in with the expectation of listening and learning a lot from the community,” she said.